Provider Demographics
NPI:1023167236
Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-335-7270
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65615-0770
Mailing Address - Country:US
Mailing Address - Phone:417-336-5100
Mailing Address - Fax:417-336-5107
Practice Address - Street 1:895 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3721
Practice Address - Country:US
Practice Address - Phone:417-336-5100
Practice Address - Fax:417-336-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI2096OtherRAILROAD MEDICARE
MO000015601Medicare PIN